Provider Demographics
NPI:1649053513
Name:LIAO, MU GUANG
Entity type:Individual
Prefix:
First Name:MU GUANG
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST STE 502
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6521
Mailing Address - Country:US
Mailing Address - Phone:718-888-9934
Mailing Address - Fax:
Practice Address - Street 1:3640 MAIN ST STE 502
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6521
Practice Address - Country:US
Practice Address - Phone:718-888-9934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist